Factors involved in aircraft assisted suicides
may be depression, social relationships, and
financial difficulties, just to name a few
problems. Suicide attempts using an aircraft
almost always result in pilot fatality; they
also have the unfortunate potential to cause
collateral damage to property and life.

Our laboratory has been interested in
epidemiological and toxicological findings from
aircraft assisted pilot suicides. Accident
information and case histories were obtained
from the National Transportation Safety Board
(NTSB) and the Federal Aviation Administration,
while toxicological information was obtained
from the Civil Aerospace Medical Institute’s
Bioaeronautical Sciences Research Laboratory.

The wife of the crazed
pilot,
Joe Stack who slammed his plane into a Texas
building said she was devastated by her
husband's suicide mission.

This paper is a 10 year review (2003 - 2012) of
aircraft assisted pilot suicides and is a follow
up to our previous 1993 2002 review. From 2003 -
2012, there were 2,758 fatal aviation accidents;
the NTSB determined that 8 were aircraft
assisted suicides (all involving the intentional
crashing of an aircraft). This number is half of
what we found in our previous 10 year review.

All pilots involved in these aircraft assisted
suicides were male, with a median age of 46
years (range 21 - 68, mean 42 ± 16 years). The
pilot was the sole occupant in 7 of the 8
aircraft that were intentionally crashed. Four
of the 8 pilots were positive for ethanol, and 2
of the 8 were positive for Selective Serotonin
Reuptake Inhibitor (SSRI) antidepressants. Based
on the limited accidents conclusively attributed
to suicide, death by the intentional crashing of
an aircraft is an infrequent and uncommon event
and has declined compared to the previous 20
years.

Information pertaining to case history, accident
information, and probable cause(s) of aviation accidents
were available either through the National
Transportation Safety Board (NTSB) or the Federal
Aviation Administration (FAA). Our laboratory gathered
medical and toxicological information on all civil
aviation fatalities that were determined by the NTSB to
result from aircraft-assisted pilot suicide.

Other information related to the accident and the
airmen’s medical certification were obtained from the
Document Imaging and Workflow System (DIWS) of the FAA’s
Civil Aerospace Medical Institute (CAMI), which records
aeromedical information and flight experience, as
reported by the pilot to the aviation medical examiner
(AME) at the time of the medical examination, which is
part of the medical certification process. Postmortem
specimens collected from pilots involved in civil
aviation accidents are analyzed at the CAMI Forensic
Toxicology Research Laboratory Toxicological information
for each suicide case was obtained from CAMI’s ToxFlo
toxicology database.

Case Histories

A
summary of events surrounding each aircraft-assisted
suicide is presented below. No evidence of aircraft
mechanical problems was found in any of the accidents.

Case 1

A
26-year-old pilot rented a Cessna 172P, requested
permission, and was cleared to taxi and takeoff.
Following this communication, the pilot did not
acknowledge any further air traffic controller
communication. Shortly after takeoff, the pilot made
approximately four 360-degree turns to the left. The
airplane then descended and impacted a wooded area (at
approximately 1751 hrs – daylight, 30 minutes before
sunset). The dispatcher at the rental company said that
the victim did not appear to display any abnormal
behavior prior to the accident. Toxicological
examination found no drugs in the pilot’s system. The
District Medical Examiner ruled the manner of death as a
suicide. Otherwise, there was no supporting information
concerning the suicide.

Case 2

A
45-year-old pilot departed the airport in a Piper
PA-28-235. Shortly after takeoff, witnesses observed the
plane fly straight into the ground (at approximately
0739 hrs – daylight, 1.5 hours after sunrise). The pilot
had a long history of depression. He had been
hospitalized twice for psychiatric problems. Three days
prior to the accident he was hospitalized due to a
suicide attempt. The day before the accident, he was
released from the hospital. The pilot did not report any
of the past psychiatric issues to the FAA. Toxicological
examination revealed the presence of antidepressants (citalopram
and fluoxetine), diphenhydramine (a sedating
antihistamine), and ethanol.

Case 3

A
69-year-old pilot with an intermittent history of
drinking and threatening suicide by aircraft, was seen
consuming alcoholic beverages at a restaurant at lunch
that day. Later that evening, he took his Beechcraft A36
out for a flight and collided with the side of a
mountain (at approximately 1958 hrs – dusk, 20 min after
sunset). Witnesses reported that the accident plane was
circling a mountain and then flew directly towards the
mountain. Radar indicated five counterclockwise circles,
followed by a rapid descent into the mountain on the
sixth circle. Toxicological examination identified
ethanol in the brain and muscle.

Case 4

A
21-year-old pilot was celebrating his 21st birthday at
the home of close acquaintances of the pilot. During his
birthday party, he became aware that the couple’s
daughter did not want to pursue a relationship with him.
Upset, he departed the party for the neighboring town,
where he lived and was employed as a helicopter flight
instructor. While his place of employment was closed, he
procured a helicopter (Robinson R44) and flew back to
the town where his birthday party was underway. He
called his friends and said he was going to commit
suicide. The helicopter crashed into an open field (at
approximately 0015 hrs – dark). A suicide note was found
in the pilot’s apartment. Toxicological examination
identified diphenhydramine and high levels of ethanol in
the blood, vitreous, muscle, and brain.

Case 5

A
47-year-old student pilot was involved in a custody
dispute over a minor child following a recent divorce.
The student pilot and minor child departed the airport
in a Cessna 150. After approximately 1.5 hrs of flight,
the aircraft appeared to be returning to the airport.
According to witnesses, just prior to the airport, the
airplane entered a steep dive into the ground (at
approximately 1035 hrs – daylight). The aircraft crashed
into the pilot’s ex-mother-in-law’s house, killing both
the student pilot and the minor passenger. Toxicology
revealed no drugs in the pilot’s system. According to
FAA regulation 14 CFR Part 61.89 (7), a student pilot is
prohibited from acting as pilot-in-command of an
aircraft carrying passengers. The event was handled by
the State Police as a murder/suicide homicide
investigation.

Case 6

A
25-year-old pilot was distraught over the recent breakup
with his girlfriend. Early one morning the pilot,
sounding inebriated, told her that he was going to
commit suicide in his aircraft. Shortly thereafter, the
pilot took a Cessna P206 from his place of employment,
where he worked as a pilot. Following an extended flight
(approximately 5 hrs), the pilot crashed the aircraft
(at approximately 1022 hrs – daylight). Visual
meteorological conditions prevailed at the time of the
accident. Toxicology testing revealed citalopram,
clonazepam metabolite (antianxiety medication), and
ethanol in his system.

Case 7

A
53-year-old pilot was experiencing business and personal
issues with the Internal Revenue Service (IRS) and other
government agencies. Angry at the IRS, the pilot
intentionally flew a Piper PA-28-236 into an office
building (at approximately 1022 hrs – daylight), killing
himself, an employee in the building, and injuring 13
other employees. A suicide note was published on the
Internet. Toxicology testing revealed no drugs in the
pilot’s system.

Case 8

A
48-year-old pilot had been experiencing difficulties in
his personal life and had expressed suicidal thoughts.
The pilot ditched a Cessna 172B, which was substantially
damaged following impact with the Atlantic Ocean (at
approximately 0430 hrs – night). A suicide note was
found inside the pilot’s automobile, which was parked in
the aircraft’s hangar. While part of the aircraft was
recovered, the pilot’s remains were not found.

Results And Discussion

The NTSB is responsible for investigating civil aviation
accidents and for determining the probable cause(s). It
may be difficult to differentiate between a suicidal and
an unintentional aviation accident when considering that
the circumstances surrounding such accidents can be
virtually indistinguishable. In order for the NTSB to
assign suicide as the probable cause of an aviation
accident, it must have significant supporting evidence,
such as a suicide note, a witness, or suicidal ideation.
With this in mind, aircraft-assisted suicides are most
likely under-reported and under-recognized; however,
Bills et al. has found that aviation crashes caused by
suicide differ from unintentional aviation accidents in
pilot characteristics, crash circumstances, and
outcomes.

For the purpose of this study, we examined only aviation
fatalities that the NTSB reported as suicide. It is
uncertain wherefrom the term “suicide” originated; most
records have attributed it to Sir Thomas Brown, who
coined it in 1643, probably from the Latin sui of
oneself and caedere to kill, as presented in the
authorized publication of his work, Religio Medici.
There are numerous definitions of suicide, ranging from
“the act of killing one’s self” to the one latest
proposed as “an act with fatal outcome, which the
deceased, knowing or expecting a potentially fatal
outcome, has initiated and carried out with the purpose
of bringing about wanted changes”. The World Health
Organization defines a suicidalact “as the injury with
varying degrees of lethal intent and suicide may be
defined as a suicidal act with fatal outcome”.

Durkheim, one of the best known early researchers on
suicide, defined suicide as “death resulting directly or
indirectly from a positive or negative act of the victim
himself, which he knows will produce this result” circa
1897. Lately, suicide has also been referred to as
intentional self-harm and self-directed violence.

In
2010, there were 38,364 suicides in the United States,
accounting for 1.6% of all deaths. This number exceeded
deaths from motor vehicles: 33,687 in 2010. From
2003-2012, there were 2,758 fatal aviation accidents,
eight of which were reported by the NTSB as being
suicide as the probable cause.

Therefore, aviation accidents resulting from intentional
pilot crashing are not common and account for 0.29% of
all fatal aviation aircraft accidents. The suicide rate
by aircraft is much lower than the overall suicide rate
in the US. Ungs reported that aircraft-assisted suicide
in the United States over the years 1979- 1989 was 0.17%
(10 out of 5,929) of all fatal general aviation
accidents. Our previous study of aircraft-assisted
suicides from 1993 – 2002 found that 0.44% (16 out of
3,648) of all fatal aviation accidents were conclusively
attributed to suicide.

The rate of aircraft-assisted suicides, compared to all
fatal aviation accidents of 0.29% (for 2003-2012), is
higher than the one found in Ungs’ study, but lower than
our previous 10-year study. With the suicide numbers
being so low compared to the total number of fatal
aviation accidents, just a few accidents determined not
to be “conclusive” as suicide can make a large
difference in the final percentage attributed to
suicide.

For example, five other aircraft accidents occurred
during the 2003-2012 period were identified where the
NTSB investigation process considered suicide as a
potential cause of the accident, but the evidence was
insufficient to assign it as such. An interesting
finding is the total number of aviation accidents have
substantially decreased from 5,929 (11-year period:
1979-1989) to 3,648 (10 years: 1993-2002) to 2,758 (10
years: 2003-2012); a decrease of 38% between the first
and second study and a decrease of 24% between the
second and current study. Three of the eight (38%)
aircraft-assisted suicides occurred in 2003, while no
cases were identified in 2004, 2005, 2008, 2009, or
2011.

All suicide flights in this study were operated as
general aviation, 14 CFR Part 91. All aircraft used in
these suicides were predominantly single-engine,
fixed-landing gear aircraft, and consisted of four
Cessna, two Piper, one Beechcraft, and one Robinson
helicopter. All of the pilots involved in these
aircraft- assisted suicides were male, with a median age
of 46 years (range 21-68, mean 42 ± 16 years). The pilot
was the sole occupant in all but one of the aircraft.
The findings of this study are similar to those found by
Ungs and our previous study. Ungs reported that all of
the aviation-assisted suicides were operated under
general aviation flight rules, and that all the suicide
victims were male, with a median age of 36 (range
29-87). Lewis et al. also found that all of the
aviation-assisted suicide flights were operated under
general aviation flight rules, and all the suicide
victims were male, with a median age of 40 years (range
15-67).

Five of the eight suicides occurred in the daylight
hours (0739, 1022 (x2), 1035, and 1751 hrs) and three at
night (0015, 0430, and 1958 hrs). The most frequent days
for suicide were Monday or Tuesday (n=5). There did not
appear to be a seasonal preference for the suicides, and
the weather was unremarkable; visual meteorological
conditions prevailed on all flights. Six of the 8 airmen
(75%) had thought of suicide, talked about suicide,
attempted suicide before, and/or left a suicide note.
Specifically, 5 had expressed recent thoughts of suicide
(63%), 4 (50%) left a suicide note, and 1 had previously
attempted suicide (13%). Also, 7 of the 8 victims (88%)
had experienced domes tic problems (88%), criminal
issues (13%), and/or depression (25%) prior to their
suicide. Table 2 summarizes these results.

All eight airmen were medically certified for flight
operations sometime in their flying career (range 4
months – 31 years, mean = 12 years), as measured by the
length of time between their first medical certification
to the date of the incident. All of the airmen had
current medical certification and, therefore, were
operating within the FAA’s aeromedical certification
regulations at the time of the accident. The time
elapsed from their last aviation medical examiner (AME)
exam to the date of the accident ranged from 3 to 15
months, with a mean of 7 months.

One airman was carrying a passenger in violation of the
rules governing his student pilot certificate. Each
airman reported to be and appeared to be in good general
health as of their last medical certification. Three of
the eight airmen were granted “clear” (unrestricted)
certification. The other five “limited” certifications
were due to the requirement of corrective lenses. At the
time of their flight certification medical examination,
five of the airmen were overweight, with a body mass
index (BMI) above 25 and an average of 27 ± 4, ranging
from 22 to 35. Their average weight was 185 ± 35 lb,
ranging from 144 to 257 lb; their height was 69 ± 3
inches, ranging from 64 to 72 inches. One airman had
reported having “problems with hay fever/allergies.” Two
other airmen had reported high blood pressure treated
with medications. Two airmen had reported orthopedic
issues that had resolved. All airmen had presented with
normal blood pressure and heart rate at the time of
their last medical examination by the AME prior to the
NTSB event. None of the airmen had reported “Mental
disorder of any sort, depression, anxiety, etc.” or
prior Suicide attempt.”

None had reported the use of any anti-depressant
medications, though toxicology testing identified
selective serotonin reuptake inhibitor (SSRI)
antidepressant medications in the tissues of two of the
airmen. Two of the airmen were private pilots. Five
airmen were commercial pilots. One was a student pilot.
Flight experience, i.e., total flight hours and flight
hours in the last 90 days.

Four of the eight airmen were positive for disqualifying
substances. Positive toxicological findings included
four ethanol positives, one positive for
benzodiazepines, and two positive for antidepressants.
Only one of these airmen had been identified as having a
problem with one of these substances (ethanol) during
the medical certification process. Two airmen undergoing
depression therapy had not reported it to their AME.
Table 4 describes these results. All but one of the four
ethanol-positive values were above the FAA cutoff of 40
mg/dL. In fact, two pilots tested positive for
significantly impairing levels of ethanol, 290 mg/dL
blood and 270 mg/dL blood. The benzodiazepine identified
in one case was 7-amino-clonazepam, the main metabolite
of clonazepam. Two victims had antidepressants – both
had citalopram and metabolite, and one had fluoxetine
and metabolite. Additionally, two were positive for
diphenhydramine, a sedating H-1 antihistamine.
Diphenhydramine is the active drug in Benadryl. Each of
the compounds found in these four aviation accident
victims have the potential to impair both judgment and
physical ability.

These substances are disqualifying and may have
contributed to the events that led to these fatal
accidents. The information gathered on the eight suicide
victims during the medical certification process
revealed that the airmen did not alert their AME or the
FAA’s Office of Aerospace Medicine of their depression
or suicidal ideation. Meanwhile, risk factors such as
previous history of psychiatric diagnosis (such as
depression or comorbid health problems) are not
sufficient to assess suicide risk; the pilot’s current
state (of mind and body) must be taken into account, so
that warning signs are identified and in a timely
manner. This approach is not facilitated by the medical
certification process, as the relationship between the
applicant pilot and the AME, the latter a representative
of the FAA, is regulatory in nature, where the aim of
the medical examination is to ensure public safety. The
successful management of suicide risk of any particular
pilot under an aeromedical setting is not viable, given
these circumstances.

Further, critical evaluation elements such as the
pilot’s sleep pattern, interests, mood, level of energy,
concentration, and appetite may not be specifically
addressed during an AME’s examination, given that such
examinations can range from every 6 months (for
first-class pilots) to every 5 years (for third-class
pilots). Indeed, a pilot seeking to be medically
certified will typically present as a content and
healthy individual, especially to the physician he/she
believes whose job is to restrict flying activities if
found otherwise. As a result, the pilot applicant is not
likely to volunteer information or present behavior that
would jeopardize his/her privilege to fly. In contrast,
the physician-patient relationship in clinical practice
does not pose this “threat”; it foments a more personal
relationship that is exercised more often, and it is
inspired by a mutual interest in resolving existing
health issues and/or implementing preventive measures to
maintain wellness.

A
treatment for depression is the use of SSRIs. Their
effects on cognitive and psychomotor performance have
been examined by the aeromedical community relative to
the safety of SSRI use during aerospace operations. On
4/15/2010, the FAA modified its medical certification
policy on depression and began to issue certificates to
airmen diagnosed with depression who were being treated
with a single SSRI fluoxetine (Prozac), sertraline
(Zoloft), citalopram (Celexa), or escitalopram (Lexapro).
The conditions for issuance of a medical certificate
include that for a minimum of 12 continuous months
prior, the applicant must have been clinically stable as
well as on a stable dose of medication without any
aeromedically significant side effects and/or an
increase in symptoms.

Conclusion

While pilot-assisted suicides do occur, they are
uncommon, accounting for less than one-half of 1 percent
of all fatal general aviation accidents.
Aircraft-assisted pilot suicide is a tragic but rare
occurrence in aircraft crash events. Suicides accounted
for only eight events of the 2,758 fatal aviation
accidents between 2003 and 2012. All of the suicides
involved general aviation operations. Most of the
suicide-pilots were experiencing significant stressors
in their lives at the time of their demise.
Toxicological data indicate that 50% (four of eight) of
all aviation-assisted suicide-pilots involved at least
one, if not more, disqualifying substances, and 38%
(three of eight) had impairing levels of such substances
in their system. No information provided during the
medical certification process identified suicidal
ideation or evidence of depression. The suicides
presented here were likely precipitated by events
occurring after the medical certification process had
been conducted, reviewed, and completed.

Humankind has always faced the question on the meaning
of life, if any. It seems appropriate to recall Camus’
view on the subject (29): “There is but one truly
serious philosophical problem, and that is suicide.
Judging whether life is or is not worth living amounts
to answering the fundamental question of philosophy. All
the rest whether or not the world has three dimensions,
whether the mind has nine or twelve categories comes
afterwards. These are games; one must first answer [the
question of suicide]. And if it is true, as Nietzsche
claimed, that a philosopher, to deserve our respect,
must preach by example, you can appreciate the
importance of that reply, for it will precede the
definitive act. These are facts the heart can feel; yet
they call for careful study before they become clear to
the intellect.”